Opioid Side Effects & Treatment for Opioid Withdrawal Symptoms

Reviewed By: Pramod Kerkar, MD, FFARCSI

What are Opioids?

Opioids are medicines, which are used to give relief from pain. Opioids work by reducing the intensity of the pain signals transmitted to the brain and also affect the areas of the brain which control emotion and decrease the effects of a painful stimulus. Some of the opioids include morphine, hydrocodone, oxycodone, codeine etc. Hydrocodone is the most commonly prescribed opioid for relieving different types of painful conditions, such as pain from injury or trauma or pain from dental procedures. Morphine is an opioid, which is commonly used before and after surgery to relieve severe pain. For mild pain, codeine is often prescribed. Other than relieving pain, some opioids, such as diphenoxylate and codeine, are used for purposes other than relieving pain, such as for relieving severe diarrhea and coughs.

The plus side of opioids is that they are very effective and useful in managing pain. The down side of opioids is that Opioids are the most abused drugs used in USA, as they are readily prescribed, easily attainable and very addictive, all which makes for a lethal combination. As mentioned before, opioids are very effective in controlling pain and also they are relatively cheap. Morphine has been present for more than a century and is still used for controlling pain on a regular basis.

Opioid Side Effects

Affect of Opioids on the Brain & Body

The action of the opioids occurs when they attach to the opioid receptors the special proteins found in the spinal cord, gastrointestinal tract, brain and other organs of the body. Attaching of the opioids to the opioid receptors reduce the perception of pain. Some of the side effects of Opioids include drowsiness, nausea, mental confusion and constipation. Depending on the quantity of the drug taken, patient can also experience depressed respiration. In some patients, there is a feeling of euphoria after taking opioids, as these medications affect some parts of the brain. Some people can abuse opioids by taking them in a manner which is different than prescribed, e.g. oxycontin is used to treat moderate to severe pain by releasing the opioid in a slow and steady manner. Oxycontin is abused by people by injecting or snorting it, which increases their risk for serious complications, including overdose.

Consequences of Use & Abuse of Opioids

When opioids are taken according to doctor’s instructions, then they help a great deal in safe and effective management of pain. However, abuse of opioids, even if the patient takes a single large dose, can result in severe respiratory depression and even cause death. If opioids are used in the correct prescribed manner, then using opioid analgesics for short-term rarely causes addiction. Prolonged or regular use of opioids where they are taken many times a day for several weeks or abuse of opioids can cause physical dependence and even addiction. Physical dependence is different from addiction. Physical dependence is the body’s normal adaptation/response to long term exposure to any medicine. Addiction is compulsive taking of any medicine for recreational use. In both cases, i.e. physical dependence as well as addiction of opioids, patient can experience withdrawal symptoms if the medicine is abruptly reduced or stopped. These withdrawal symptoms comprise of restlessness, insomnia, muscle and bone pain, vomiting, diarrhea, goose bumps, cold flashes and involuntary leg movements.

Opioids often produce a feeling of "high" in patients. The more faster-acting they are, the powerful is the “high” produced. Some of the short-term effects of opioids include: Pain relief, euphoria, sedation and drowsiness. The side effects of Opioids include lethargy, drowsiness, paranoia, nausea and respiratory depression. Due to the intense “high” which is produced by the interaction of opioids and the brain, these medicines are extremely addictive, and in some cases can cause addiction within a few days of use. Opioids also cause relaxation of irises causing the pupils to become constricted or pinpoint, which is hard to conceal. This is one of the biggest indications of opioid abuse and it's hard to disguise.

Top 9 Opioid Side Effects

Addiction: This is one of the common side effects of prolonged opioid use. If the patient already has a history of addiction or substance abuse (prescription drugs, alcohol, illegal drugs etc.), then they are even more at risk for opioid addiction. They become addicted to opioids without realizing it. Patient is said to develop an addiction when he/she cannot get off the drug despite experiencing the side effects of the opioids. Patient can also be stealing opioids or money to fund their addiction. The relationship of the patient with others tends to suffer because of this habit. There will be a decline in the work performance of the patient resulting in financial problems.

Cognitive Changes: Cognitive changes, such as confusion is also one of the side effects of opioids use, as these medicines act on the central nervous system making the patient feel confused with decreased alertness, slow thinking and coordination. Patient often feels these cognitive changes, such as feeling foggy when the medicine is newly started or the dose is increased.

Respiratory Depression: Patient can also experience problems with breathing, which include unusual, slowed breathing. This occurs due to the method in which the pain medicines act on the respiratory center in the brain. This can be one of the most harmful reactions to opioids. There is blunting in the ability of the body to regulate breathing. Overdose of the opioids can also cause side effects of respiratory depression. So, it is important that the patient starts on lower doses and the dosage is slowly increased.

Drowsiness: There are about 30% to 60% patients who will experience side effects of drowsiness with opioid drugs. Due to this opioid side effect, individuals in certain professions, such as pilots, drivers or people who have to operate heavy machinery need to follow special laws and regulations for prescription drug use. Patient commonly experiences drowsiness immediately after starting on the opioids or after increasing their dose. The doctor needs to be careful and observe the patient carefully when starting opioids and during dosage adjustments. As the patient becomes used to the medication, the drowsiness will also slowly recede.

Constipation: There is some degree of constipation experienced by almost all the patients who take opioids. This is because medicines, which act on the pain receptors, also tend to affect the gut. This side effect can be avoided by using stool softener/laxative along with the opioid medicine.

Nausea: This side effect can occur in about 25% of patients who are using opioids. The mechanism for nausea is the same which causes constipation. However, unlike constipation, the nausea gradually subsides, as the patient gets used to opioids.

Itching: Some patients who are using opioids can experience itching all over the body, which resembles an allergic reaction. The widespread itchiness is not an allergic reaction to the opioids and though it is not dangerous, it can be quite bothersome. Itching as a side effect to the opioids commonly occurs when morphine is injected into the spine. If decreasing the dose does not relieve itching, then an antihistamine should be prescribed, such as Benadryl.

Overdose: This opioid side effect can occur if the patient increases his/her dosage along with developing a tolerance to opioids. As the medicine slowly accumulates in the body, patient experiences slowed breathing, dizziness, decreased heartbeat and seizures. So, it is important to realize when the medications are not working and slowly taper them off instead of increasing the dosage.

Sexual Side Effects from Opioids: Chronic pain and having to take medicines for the pain, such as opioids takes a toll on the patent’s sex life. Opioids tend to decrease testosterone levels and lead to erectile dysfunction in men, which can also cause difficulty with orgasm in both males and females.

Safety of Opioid Use with Other Medications

It is important to use other medications with opioids only under doctor’s supervision. Opioids typically should not be used with other medicines or elements, which also depress the CNS system, such as antihistamines, benzodiazepines, alcohol, barbiturates or general anesthetics, as this type of combination greatly increases the risk of fatal respiratory depression.

Treatment for Opioid Withdrawal Symptoms

Withdrawal from opioids can be very uncomfortable, sometimes where the patient can have acute symptoms resembling flu. Treatment of opioids withdrawal symptoms comprises of supervised detoxification of the patient in order to maximize his/her safety and comfort during the withdrawal process and to reduce the risk of relapse. Dependency of opioids can be quite stubborn, so it is often recommended that a minimum period of three months is needed for the patient to get off opioids and to get into recovery. Some patients can take more than three months for the whole process of coming out of dependency of opioids and going towards recovery.

Treatment during opioid withdrawal often comprises of use of a replacement opioid, such as methadone or buprenorphine. This helps in creating a better stability in the patient during the detox process. The dose of the replacement opioid is gradually reduced and the patient can have few withdrawal symptoms, which are minor when compared to the huge amount of withdrawal symptoms experienced by the patient if he/she suddenly stops the drug (cold turkey). During the withdrawal treatment, it is important that the patient also undergo therapy and attend counseling sessions. Joining a peer support group is also strongly recommended, as it can help prevent relapse and avoid triggers.